LPI Homeowner's Discount Questionnaire

LPI Homeowner's Discount Questionnaire
Name:
Tel.
Email:
Address of Insured Property:
Are Any of the Following Devices installed on Property:
Alarm System

Yes No
Install Date:

Month Day Year
at
Hour Minutes AM/PM Option Date Picker Icon
Backwater Valve

Yes No
Install Date:

Month Day Year Date Picker Icon
Alarmed Sump Pump (ASP):

Yes No
Install Date

Month Day Year Date Picker Icon
Does ASP have Battery BackUp?

Yes No
Automatic Water Shut-Off System

Yes No
Install Date:

Month Day Year Date Picker Icon
When was your Hot Water Tank last Replaced:

Month Day Year Date Picker Icon
Is your Hot Water Tank Tankless:

Yes No
When was your Roof last Replaced?

Month Day Year Date Picker Icon
Does Property Sit on a Septic Field?

Yes No
Does Property have an Unfinished Basement:

Yes No
What kind of Siding does Property have on Exterior? (%)
Please list all types of siding and percentage of cover for each:
%
%
%
Does your property have a Mortgage or Line of Credit?

Yes No
If Yes, Please Name Lender(s) and Provide Amount(s)
Are You willing to provide your insurer with a Credit Score Consent?

Yes No
Should be Empty: